The first genomic monitoring of Klebsiella bacteria in Ghana has shown that antibiotic-resistant pathogens are found only in hospital settings, an insight that could be used to help inform control measures.
Some highly antibiotic-resistant strains of bacteria in Ghana are not successful in spreading outside the hospital, suggesting that control measures can be focused on clinical settings to help limit treatment-resistant infections.
Scientists, from the Wellcome Sanger Institute, Oslo University Hospitals, University for Development Studies, Ghana and colleagues, used a One Health1 approach to understand the spread of antibiotic resistance in Klebsiella pneumoniae (K. pneumoniae) bacteria in Ghana. It is a bacterial species that has the ability to cause a wide range of infections.
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The study, published today (October 16, 2023) in The Lancet germ found that strains of these bacteria that cause typical treatment-resistant infections were found only in clinical settings, at rates similar to those observed in Italy.
Hardly antibiotic-resistant strains were not found in the environment or in animals, suggesting that their persistence outside hospitals is currently minimal in this area of Ghana. The researchers point to the clinical use of antibiotics causing this resistance Klebsiella pneumoniaeand emphasize the importance of using genetic data to inform control measures.
Klebsiella pneumoniae, belonging to the wider Klebsiella genus, is an important human pathogen. It has the ability to cause a wide range of infections, including pneumonia, meningitis, wound and soft tissue infection, urinary tract infections, and is the leading cause of neonatal sepsis.2
Antibiotic resistance, otherwise known as multidrug resistance, in K. pneumoniae is steadily increasing.2 Certain strains of bacteria are able to produce enzymes known as extended-spectrum beta-lactamases (ESBLs), making them resistant to certain types of antibiotics, including penicillin.
Other executives of K. pneumoniae have become resistant to carbapenems, a broad-spectrum antibiotic used for infections that do not respond to other treatments.
While there was genomic surveillance of him Klebsiella in many European countries, there are many countries where data is still needed.
In this research, the team from the Wellcome Sanger Institute, University of Oslo, University for Development Studies, Ghana and colleagues sequenced 573 Klebsiella samples collected from clinical, environmental and animal sources in and around the city of Tamale, Ghana.
These data were also compared with previous studies they investigated Klebsiella from Pavia, Italy and Tromsø, Norway.
Among the nearly 600 Klebsiella isolates were sequenced, the researchers found that K. pneumoniae make up two-thirds of it. The team identified two carbapenem-resistant strains and multiple strains containing ESBL genes, which confer resistance to other antibiotics. However, these were only in samples obtained from clinical facilities. This level of antibiotic resistance was rare in environmental samples, suggesting that these strains are less successful outside the hospital.
The researchers suggest that the clinical use of antibiotics, such as carbapenems, has led to the rise of antibiotic resistance. Without this selective pressure, these resistant strains do not compete with other, less dangerous forms of bacteria.
This insight could help inform public health measures focused on reducing the spread of highly antibiotic-resistant bacteria in hospitals and underscores the importance of genomic surveillance.
“Being able to map the spread of bacteria that can cause treatment-resistant and potentially life-threatening infections is crucial to developing methods to help stop this. Our study shows that while the use of antibiotics has increased the number of resistant strains Klebsiella pneumoniae, these strains are not as efficient at spreading into the wider environment. Identifying strains that overcome these could be a useful tool to reduce levels of resistant strains or to inform measures to limit the spread.”
Dr. Jessica Calland,first author from Oslo University Hospitals
“Resistant to treatment Klebsiella pneumoniae is a growing and ongoing issue in Ghana. However, prior to this study, we did not have robust genomic surveillance data to understand which strains and types of resistance we were dealing with. Our research shows how important it is to undertake genomic surveillance work in all countries, especially those particularly affected by treatment-resistant pathogens, as these may enter the environment due to ineffective treatment of hospital wastewater.”
Professor Kourage Koshi Setsoafia Saba,co-senior author from the University for Development Studies, Ghana
“Using the One Health approach, our study takes into account all the different environments in an area, including hospitals, people and other animals, where bacteria can persist. This allows us to have a more complete view of all possible pathways in an area, and without it efforts to stop the spread of bacteria could have potential blind spots. Using this approach allowed us to see that multidrug-resistant strains in Ghana were only found in hospitals, validating the extent of antibiotic misuse in medicine and showing where interventions can now be focused.”
Dr. Akosua Karikari,co-senior author from the University for Development Studies, Ghana
“Antibiotic resistance in bacteria is a global public health problem, affecting every country. Our study highlights this by finding the same genes conferring resistance at similar levels in both Ghana and Italy. Having detailed genomic information about the spread of antibiotic resistance and the factors influencing it is vital if we are to try to be able to slow it down and eventually stop it. While many genomic surveillance studies have been done in European and Western countries, our study works with international partners to help inform the situation in a more global setting. Cross-border collaboration will be key to effectively combating antibiotic-resistant bacteria and reducing their negative impact on public health worldwide.”
Professor Jukka Corander,co-senior author from the Wellcome Sanger Institute